Many surgical procedures require fixing tissue with respect to bone, artificial anchors, or other tissue using sutures. A variety of stitches are known that can be utilized to position and fix a portion of tissue at a desired location. However, passing sutures through tissue to create one or more stitches can be challenging due to the confined working space of a patient's body and the limited accessibility of the tissue. This is especially true in minimally invasive surgical procedures that require surgical tools to be inserted into a patient's body through small diameter cannulas, thereby preventing a user from directly manipulating a suture or tissue.
Several suture passing instruments have been developed in response to these and other challenges that allow a user to grasp a portion of tissue and pass a suture through the grasped tissue. The portion of the suture passed through the tissue can then be grasped with a second tool and further manipulated. One example of a suture passing instrument is described in U.S. Pat. No. 7,879,046 to Weinert et al., entitled “Suturing Apparatus and Method,” the contents of which are hereby incorporated by reference in their entirety. A number of other suture passing instruments are also known in the art.
One challenge faced by users of suture passing instruments is the need to repeatedly remove the instrument from a patient's body for reloading. As mentioned above, a variety of stitches are known that can be used in positioning and fixing tissue, and most stitches require passing multiple portions of one or more suture strands through tissue at one or more locations. Using known devices and methods, a user loads a single suture into a suture passing instrument, inserts and positions the instrument within a patient's body, passes the suture through tissue, and removes the instrument from the patient's body to repeat these steps for each additional suture that must be passed through tissue.
The repeated insertion and removal of the suture passing instrument from the patient's body can introduce a number of challenges. For example, sutures passed through tissue often have a free end extending through the cannula used to insert the suture passing instrument so that a user can further manipulate the suture during the procedure. Repeatedly removing the suture passing instrument and reintroducing it through the cannula can risk snagging or entangling the instrument with one or more of the suture free ends extending through the cannula. Furthermore, removing and reintroducing the suture passing instrument can distort a user's frame of reference for creating a stitching pattern because the instrument must be positioned anew for each suture passing. Still further, in some procedures it can be desirable to pass multiple sutures through a single hole in tissue. It is difficult to reposition the suture passing instrument after removing it from the body for reloading such that a second suture can be passed through the same hole as a first suture. These challenges add time and difficulty to surgical procedures that require passing multiple sutures through tissue.
Accordingly, there is a need for novel methods for passing multiple sutures through tissue in a more efficient manner. In particular, there is a need for improved methods for loading and utilizing existing suture passing instruments to pass multiple sutures through tissue and reduce the challenges associated with repeatedly inserting and removing a suture passing instrument from a patient's body.